Reason Code 96 | Remark Codes M114 M115 N211 - JD DME
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Reason Code 96 | Remark Codes M114 M115 N211
Code | Description |
---|---|
Reason Code: 96 | Non-covered charge(s). |
Remark Code: M114, M115, N211 |
|
Common Reasons for Denial
- Medicare does not pay for this item or supply when provided by a non-contract supplier
- Only contract suppliers may provide brace with the exception of Non-Contract Physicians and Other Treating Practitioners, Physical Therapists, and Occupational Therapists with special modifiers and non-contract suppliers providing items to a traveling beneficiary
Next Step
- Non-Contracted Suppliers submitting claims for beneficiaries that reside in a CBA and do not meet the definition of a traveling beneficiary, will need to obtain a properly executed ABN, prior to providing item, for off-the-shelf (OTS) back and knee braces, with the exception of Non-Contract Physicians and Other Treating Practitioners, Physical Therapists, and Occupational Therapists. Suppliers that provide off-the-shelf (OTS) back and knees braces without a properly executed ABN cannot collect payment from the beneficiary
How to Avoid Future Denials
- Check eligibility on the Noridian Medicare Portal to verify the beneficiary's permanent address on file with the Social Security Administration prior to providing service.
- Utilize the Round 2021 CBA Zip Code Lookup Tool to verify if beneficiary's permanent address resides in a CBA
- Only contract suppliers may provide brace with the exception of Non-Contract Physicians and Other Treating Practitioners, Physical Therapists, and Occupational Therapists and non-contract suppliers providing items to a traveling beneficiary
- Utilize the Competitive Bid HCPCS Lookup Tool to verify if item is a competitive bid item and if item requires prior authorization, face-to-face and written order prior to delivery
- Please refer to the Competitive Bidding page on the Noridian Medicare website for more information.
Last Updated Tue, 28 Feb 2023 16:20:57 +0000